Computed tomography quantification of bone density adjacent to cemented pegged polyethylene glenoid components in shoulder arthroplasty.

BACKGROUND: Cemented polyethylene devices are the prostheses implanted more frequently, but there is no agreement on the optimal glenoid component design. In this study, bone mineral density (BMD) adjacent to cemented all-polyethylene glenoid components was assessed to gain insights into the characteristics of glenoid bone as a potential risk factor implicated in the failure of shoulder arthroplasty. PATIENTS AND METHODS: Twenty-two subjects were examined at an average follow-up of 31 months using the Constant-Murley score (CS) and multi-detector computed tomography. BMD was measured in 5 regions of interest (ROIs) at the sites where radiolucent lines are usually detected. BMD differences among the ROIs were tested. The relationship between BMD and a number of variables (CS subscores, age, gender, follow-up duration) was explored. RESULTS: There was a significant increase in CS scores (p<0.05). Significantly different BMD (p=0.0039) was found in the 5 ROIs, especially between ROIs 2 and 5 (p=0.016, Bonferroni's test) and between ROIs 3 and 5 (p=0.005, Bonferroni's test). BMD was lower in ROI 1 than ROI 3 and in ROI 2 than ROI 4, but the difference was not significant. DISCUSSION: The heterogeneous BMD distribution may be related to: (1) an interindividual variability in glenoid BMD; (2) the fixation technique; or (3) the different bone response to eccentric loading of the prosthetic head on the glenoid component. CONCLUSIONS: BMD analysis may contribute to extent our knowledge on glenoid component loosening and encourage further techniques of glenoid fixation.

Dietary calcium intake in patients with inflammatory bowel disease.

BACKGROUND & AIMS: Osteopenia and increased risk for fractures in IBD result from several factors. AIM OF THE STUDY: To investigate the dietary intake of calcium in IBD patients. METHODS: A 22-item quantitative validated frequency food questionnaire was used for quantifying dietary calcium in relation to gender and age, in 187 IBD patients, 420 normal- and 276 diseased controls. STATISTICAL ANALYSIS: Mann-Whitney, chi-square- and T-tests. RESULTS: The mean calcium intake was 991.0 ± 536.0 (105.8% Recommended Daily Allowances) and 867.6 ± 562.7 SD mg/day (93.8% RDA) in healthy and diseased controls, and 837.8 ± 482.0 SD mg/day (92.7% RDA) in IBD, P<0.001. Calcium intake was high in celiac disease (1165.7 ± 798.8 SD mg/day, 120% RDA), and non-significantly lower in ulcerative colitis than in Crohn's disease (798.7 ± 544.1 SD mg/day vs 881.9 ± 433.0). CD and UC females, but not males, had a mean calcium intake well under RDA. In all study groups the intake was lower in patients believing that consumption of lactose-containing food induced symptoms, versus those who did not (105.8% vs 114.3% RDA in normal controls; 100.4% vs 87.6% RDA in IBD). CONCLUSIONS: Diet in IBD patients contained significantly less calcium than in healthy controls. Gender and age, more than diagnosis, are central in determining inadequate calcium intake, more so in IBD. Self-reported lactose intolerance, leading to dietary restrictions, is the single major determinant of low calcium intake. Inadequate calcium intake is present in one third of IBD patients and represents a reversible risk factor for osteoporosis, suggesting the need for tailored nutritional advice in IBD.

The usefulness of spiral Computed Tomography and colour-Doppler ultrasonography to predict portal-mesenteric trunk involvement in pancreatic cancer.

PURPOSE: The aim of this study was to determine the clinical utility of spiral computed tomography (CT) and colour Doppler ultrasonography (US) in the evaluation of portal-mesenteric trunk (PMT) involvement in pancreatic cancer. MATERIALS AND METHODS: Ninety-five patients with pancreatic cancer underwent preoperative assessment of the PMT with spiral CT and colour Doppler US. Five stages of vascular involvement were established. During surgery intraoperative US was performed to confirm the preoperative findings. RESULTS: Of the 95 patients observed, 82 (86.3%) underwent surgery. The sensitivity of spiral CT was 98%, specificity 79%, overall accuracy 80.2%. The positive predictive value was 87.5%; the negative predictive value 96%. The results of colour Doppler US were 92.3%, 72,7%, 72.8%, 79.5% and 88.8%, respectively. CONCLUSIONS: The results indicate that spiral CT is the gold standard in detecting PMT involvement in pancreatic cancer. Colour Doppler US is useful, but adds nothing to CT. Both of these techniques improve the possibility of predicting the resectability of pancreatic cancer.